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body mechanics
coordinated efforts of musculoskeletal and nervous systems to maintain balance, posture and body alignmentused for lifting, bending, moving and daily activities TERM 2
body alignment
DEFINITION 2 relationship of one body part to anotherBody alignment is the optimal placement of the body parts so that the skeletal bones are efficiently used, so the muscles have to do less work for the same effect. TERM 3
body balance
DEFINITION 3 achieved by a low center of gravity and enhanced by posture TERM 4
coordinated body movement
DEFINITION 4 must overcome an object's weight and be aware of its center of gravity TERM 5
friction
DEFINITION 5 rubbing together or resistance when a moving body meets a surface, often when turning a patient you will create friction with the bed.
regulation of movement
controlled by skeletal system, muscle and nervous system (cerebellum control balance & movement)skeletal system: bones, joints, ligaments, tendons, cartilageskeletal muscle: movement, posture, groups, synergistic (cooperation of body parts) and anti- gravitynervous system: regulates movement and posture, proprioception (sense of one's body position), balance (cerebellum) TERM 7
pathological influences on body alignment
DEFINITION 7 exercise and activitycongenital defects: osteogenesis imperfecta, scoliosisCNS damage: damage to any component that regulates voluntary movementdisorders of bones, joints or muscles: osteoporosis (prone to fracture, inflammatory and noninflammatory joint disease)musculoskeletal trauma: bruises, contusions, sprains and fractures TERM 8
growth and development age groups
DEFINITION 8 newborntoddleradolescentelderly TERM 9
Fowler position
DEFINITION 9 head of bed elevated, support and align hips and spine 90 degreesSEMI-FOWLER: 45-60 degrees TERM 10
Supine
DEFINITION 10 lying on back, support with pillows, trochanter rolls or splints
range of motion
exercises
can be:active: patient can move jointspassive: RN moves patient's joints TERM 17
walking aides
DEFINITION 17 walker: most securecanes: don't have wide base of support, goes on strong (uninjured) sidequad cane: has four legs and more stable than regular canecrutches (on stairs): if only one crutch it goes on the strong side, step with strong leg first (not crutch), then bring crutch and then bring weak leg up TERM 18
nursing process of body mechanics
DEFINITION 18 Assess: body alignment (standing, sitting, recumbent (lying down)), mobility(range of motion, gait, exercise, activity tolerance)Diagnosis: activity tolerance, risk for activity tolerance, distured body image, impaired physical mobility, acute pain, chronic pain, impaired skin integrity or risk for impaired skin integrityPlanning: set goals and outcomes, set priorities and use collaborative care TERM 19
Medication names
DEFINITION 19 Chemical: chemicals that compose the medGeneric: generally found under the brand nameBrand name: Largest name on top, usually bolded, name used for marketing of med TERM 20
Medication classifications
DEFINITION 20 How it works on the body:DiureticsAnti-diabeticsBeta- blockersNSAIDs
Medication forms
capsule: captablet: tabintravenous: IVsubcutaneous injection: subcutintramuscular: IMoral suspensionsyrup TERM 22
Medication legislation/
standards
DEFINITION 22 Government regulations, health care institutions and medication laws, medication regulations and nursing practice, nontherapeutic medication use(ex, after 3 days of inpatient stay an MD order is invalid, must be rewritten if MD wants continued)(ex, verbal order may be given from MD to nurse, but must be signed within 24 hours) TERM 23
Pharmokinectics
DEFINITION 23 Study of what a body does to a drug (opposite of pharmcodynamics which is what a drug does to a body). TERM 24
Pharmacodynamics
DEFINITION 24 Pharmacodynamics is the study of the biochemical and physiological effects of drugs on the body or on microorganisms or parasites within or on the body and the mechanisms of drug action and the relationship between drug concentration and effect.Studies how meds:enter the bodyreach the site of actionmetabolizeexit the body TERM 25
Absorption of meds
DEFINITION 25 Passage of medication into the blood from the site of administration5 factors that influence administration:Route of admin (IM faster than subcut)Ability of med to dissolve (liquid faster than pill)Blood flow from the area of absorption (food increases absorp.)Body surface areaLipid solubility of the med
Needle
gauges
Hypodermic needles are available in a wide variety of outer diameters described by gauge numbers. Smaller gauge numbers indicate larger outer diameters.25 gauge is smaller than 18 gauge25 is standard subcut21 is standard for IM TERM 32
Rapid acting Insulin
DEFINITION 32 All are clear solutionsRegular (short acting): take 30 minutes to work subcut or IVHumalog (lispro): 5 minutes before a mealNovolog (aspart): subcut or IVAprida (glulisine): subcut or IV TERM 33
Intermediate acting Insulin
DEFINITION 33 Solutions are cloudyNPH (neutral protamine Hagedorn)1. hours to work TERM 34
Long acting Insulin
DEFINITION 34 Cannot be mixed!Usually works for 24 hoursLantus (insulin glargine): clear, subcut ONLY, no peaks, lasts 24 hours, give at same time dailyLevimir (detemir): clear, subcut, not as long as lantus (may need 2 doses) TERM 35
Needle stick prevention
DEFINITION 35 Use needleless systemsNEVER recap a needle!plan disposal of needle and syringe prior to procedureimmediately dispose of after usedocument injury
Calculations for meds
Metric (kg, gram, mg, mcg), household (pint, oz, tsp, tbsp)solutions (concentration of mass/volume)D/H x Q = amount to administer, which means dose/have x quantitypediatric dosages: weight based, 3x more likely to experience medication errors TERM 37
7 Med Order Essentials
DEFINITION 37
- Patient's full name2. Date and time written3. Name of med4. Dosage5. Route6. Frequency7. Signature of prescriber or proxy TERM 38
Verbal Order
DEFINITION 38 Listen, repeat back, confirm. MUST BE SIGNED IN 24 HOURS!Patient nameAge and weight when appropriateDrug name (confirm spelling)DosageExact StrengthDose, frequency and routeQuantity and/or durationPurpose or indicationSpecific instructional use/Name of prescriber & individual transcrib. TERM 39
Med Distribution System
DEFINITION 39 Unit dose (single dose) or automated dispensing system (PIXUS)Nurse's role with system: administer correctly, monitor side effects, assess for patient self medication, patient and family education TERM 40
Medication Errors
DEFINITION 40 A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient.Inaccurate prescribing, wrong medication, route and time, extra doses or failing to administerReporting: written report within 24 hours of occurrenceComparison of meds taken at home and prescribed when in a health care setting
Accucheck errors
Finger not cleaned completely, squeezing finger too hard to obtain blood specimen, cleaning finger with alcohol, failure to cover the test strip completely, ignoring low battery warning, hypovolemic patient, physiological changes include out of range hemoglobin or uric acid levelTight glucose control equals better outcomes, in hospital should range between 90-180 mg/dl TERM 47
Proper Accucheck procedures (pt. 1)
DEFINITION 47 Use standard precautions (wash hands, wear gloves)When cleaning meter, use leach wipes or anti-germicide wipes when meter is contaminated, avoid wiping LCD windowFor isolation patients, place handheld in plastic bag with only test strip exposed, wipe meter down after use TERM 48
Proper Accucheck procedures (pt. 2)
DEFINITION 48
- Wash patient finger with soap and water2. Choose site on the side of finger pad3. wipe away first drop of blood to reduce tissue fluid contamination4. touch 2nd drop of blood to the edge of yellow window (not top-capillary action) no yellow should be visible (can reapply in 15 seconds) TERM 49
Blood sugar
DEFINITION 49 If too low (under 80) treat and verify resultsCritical values are anything less than 40, treat, verify results, notify MD, document TERM 50
Rule of 15 with diabetes
DEFINITION 50 If patient is symptomatic and glucose is less than 80, give 15g carbs (4 oz juice/non-diet soda, 8 oz milk, 3 graham crackers, 15gm glucose gel)If patient cannot take oral give IV d50 25 ml, repeat test in 15 min.If patient is symptomatic, treat then retestIf patient is asymptomatic, retest then treat hypoglycemia
Cardiopulmonary Physiology
Ventilation: movement of air in and out of lungs, occurs in the alveoliRespiration: exchange of O2 and CO2Diffusion: movement of gases between air spaces and blood stream, CNS must be intact for this to occurPerfusion: movement of blood into and out of lungs to organs and tissues...heart pumps blood to tissues TERM 52
Pulmonary Anatomy
DEFINITION 52 2 lungs, R lung has 3 lobes and is more prone to aspiration pneumonia, L lung has 2 lobes, trachea, R and L main stem bronchus, bronchioles, alveoli TERM 53
Ventilation
Regulators
DEFINITION 53 Neural regulators: CNS sends signal to chest wall to control rate, depth and rhythm of ventilationChemical regulators: CO2 and H+ affect rate and depth of ventilationOxygen transport: influences ventilation and perfusionCarbon dioxide transport: dissolved in plasma, carbamino compounds, bicarbinate TERM 54
Pulmonary Alterations
DEFINITION 54 Hypoxia: inadequate tissue O2 at a cellular level, could be caused by anemia, will see peripheral cyanosis (blue lips, fingers, toes)Hypoventilation: inadequate ventilation to meet body's demand, can be caused by CO2 poisoning, head trauma or hyperventilatingHyperventilation: increase in respiratory rate, seen in fever, anxiety, acid-base imbalance, causes light- headedness and tachycardia TERM 55
Regulation of blood flow (pt. 1)
DEFINITION 55 Afterload: resistance of ejection of blood from left ventricle of heart into the aorta that the heart must overcome (resistance by aortic pressure)Cardiac Output (CO): amount of blood ejected by left ventricle each minute Myocardial contractility: ability of heart to squeeze blood from ventricle before the next beatPreload: amount of blood at the end of ventricular diastole (just before it contracts)
A Fib (atrial fibrilation)
AFib (atrial fibrilation): the most common electrical disturbance of the heart, irregular quivers as opposed to full contractionCan lose 20-25% of blood that would fill ventricle affecting CO and possibly BP, stagnant blood sitting in atrium can lead to clot formation TERM 62
Circulatory System Function
DEFINITION 62 Delivers oxygen and nutrients to support cellular lifeRemove waste products and deliver them to lungs and kidney for excretionPumping action of heart supports this sytem TERM 63
Factors affecting oxygenation (pt. 1)
DEFINITION 63 Decrease in O2 carrying capacity: reduced hemoglobin, carbon monoxide poisoning, anemiaIncreased metabolic rate: hypercapnia (too much CO2), hypoxemia, fever, pregnancy, wound healingDecreased oxygen concentration: obstruction, decreased environmental oxygenChest wall movement: musculoskeletal abnormality, nervous system disease, traumaPremature infants: diminished surfactant, lung collapse TERM 64
Factors affecting oxygenation (pt. 2)
DEFINITION 64 Infants and children: likely to put things in the mouth that they can aspirate or obstruct airwaySchool age/ adolescent: 2nd hand smoke and pregnancyYoung/Middle-aged: Smoking, poor diet, lack of exercise, high stressOlder adults: chronic illnesses, coronary artery disease, heart disease TERM 65
Lifestyle Factors
DEFINITION 65 Nutrition/hydration: high fat (blocks arteries), high salt (increases BP and HR)Cigarette smoking: nicotine vasoconstricts (possible DVT), destroys cilia in respiratory tract, cancer, asthmaExercise: you need it! Decreasses stress, deeper breaths, lowers HR and BPSubstance abuse: ETOH/drugs, infections, sepsis, HIV/AIDSEnvironmental factors: urban settings (smog, air pollution), old homes (asbestos, lead paint)
Abnormal Chest Wall
Movement
Retraction (patients lose weight because they cannot breath and don't want to eat)Paradoxial breathing/flail chest: left side in and right side out, vice-versaIncreased anteroposterior diameter: barrel chest (COPD and emphysema) TERM 67
Pulmonary Acute Care
DEFINITION 67 Dyspnea management: medications, oxygen therapy (need Rx), physical and psychosocial techniquesMaintenance and promotion of oxygenation: oxygen supply, methods of oxygen delivery, hydration, humidification, nebulizationNasal cannula: 2-6L/min 24- 25% O2Venturi mask: depends on setting, usually 24-60% O2Simple mask: depends on O2 flow, usually 40-60% O2Non- rebreather mask: as close to 100% as you can get TERM 68
Coughing techniques
DEFINITION 68 Cascade: series of coughs througout exhalations, slow deep breath in and slow deep breath out to produce coughHuff: while exhaling open the epiglottis by saying "huff", deep breath in and hard exhale saying "huff"Quad: push the diaphragm inward and upward for very weak patient's deep breath in, push on diaphragm in and up to create pressure for harder cough TERM 69
Suctioning techniques
DEFINITION 69 anything that goes through the trachea must be sterile technique, at most 15 seconds but in real life usually only 10 seconds, use intermittent suctioning TERM 70
Artificial Airways
DEFINITION 70 Oral: used after surgery of OD patient's to keep tongue from blocking airwayTracheal: used for a tracheotomy
